Case 267

Area of Science:

• Urology
• Radiology
• Reproductive Medicine

Background:

• Anejaculation, the absence of ejaculation, can significantly impact male fertility and family planning.
• Lifelong anejaculation in a patient with normal erections and orgasm sensation necessitates thorough investigation for underlying causes.

Purpose of the Study:

• To investigate the cause of lifelong anejaculation in a 28-year-old male patient.
• To identify any anatomical or pathological factors contributing to the anejaculatory condition.

Main Methods:

• The patient underwent a comprehensive diagnostic workup including physical examination, urine cytology for retrograde ejaculation, genetic testing for Y chromosome microdeletions, and hormonal assays (FSH, LH, testosterone).
• Advanced imaging techniques, including pelvic MRI with dynamic contrast-enhanced study and CT urogram, were employed to evaluate pelvic anatomy.
• Cystoscopy was performed to directly visualize the intravesicular and urethral structures.

Main Results:

• Physical examination and initial tests for retrograde ejaculation and Y chromosome microdeletions were unremarkable.
• Hormonal evaluation revealed normal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, with borderline low testosterone.
• Pelvic MRI and CT urogram did not reveal significant abnormalities, but cystoscopy identified an intravesicular fluid-filled mass near the left ureteric orifice.

Conclusions:

• The presence of an intravesicular mass identified during cystoscopy is a significant finding in a patient with lifelong anejaculation.
• This mass represents a potential, previously undiagnosed, anatomical cause for the patient's anejaculation.
• Further evaluation and management of the intravesicular mass are indicated to address the patient's fertility concerns.